Prolonged Field Care Podcast

In this episode of the PFC Podcast, Dennis sits down with missionary surgeon Jason to cut through the noise on real-world wound care in austere and unconventional warfare environments. From the bridge two miles from the front to resource-scarce guerrilla settings, Jason shares hard-won lessons on getting tourniquets off, aggressive debridement, and keeping patients from dying of infection weeks later.
You’ll hear why most tourniquets can (and should) come off early, how to use the 4 C’s (Color, Consistency, Contractility, Capillary bleeding) to decide what stays and what goes, why inactivity is harm, and how daily dressing changes plus early cleaning beat the classic “leave it alone for 5 days” approach in many field conditions. Jason also covers practical logistics, antibiotic reality checks, pain management during dressing changes, and when a wound is actually ready for delayed primary closure.
Key takeaways:
Get the tourniquet completely off and look—most wounds do not need it left on.
Dead tissue, dirt, and debris are the real infection risk; antibiotics cannot fix what you leave behind.
The 4 C’s give medics a clear, actionable decision tool for debridement.
Aggressive early cleaning usually means fewer later trips to the OR, less pain, and better long-term outcomes.
In prolonged or definitive field care, the medic who stays with the patient for weeks must own the wound—not just the initial hemorrhage control.
Beefy red granulation without cellulitis is the green light for closure decisions; high-tension or complex wounds may still do better left open.

Practical, no-nonsense guidance for anyone who may have to manage wounds far beyond the golden hour.

Chapters
00:00 – Intro & welcome
00:20 – Guest intro: missionary surgeon in UW environments
01:04 – Tourniquet still on + nasty wound: what actually improves outcome?
01:19 – Get the tourniquet off as soon as possible
01:40 – Data point: ~70% of tourniquets not needed
03:11 – Why taking tourniquets off feels so scary
04:14 – Don’t lower slowly—get past venous pressure fast
05:00 – Simple method: fully loosen, look, reapply only if needed
07:17 – Risk of a brief look is low; most bleeding is manageable
09:07 – Care under fire vs. tactical field care / PFC mindset
12:25 – System solutions for large-scale conflict (push capability forward)
14:46 – Optimizing the patient after hemorrhage control15:03 – Minimal tools needed + goal of removing barriers to healing
16:18 – The 4 C’s of viable tissue (Color, Consistency, Contractility, Capillary bleeding)
17:15 – Lean aggressive: dead tissue + debris kills more than a little extra muscle
19:05 – Fungal/opportunistic infections and why clean tissue matters
22:13 – Early and repeated debridement until only living tissue remains
24:00 – How far to go: check compartments, cut questionable tissue
30:33 – Dressing strategy after initial debridement
30:38 – Copeland method vs. daily (or more frequent) changes
33:12 – Checking the wound the next day in austere settings
34:34 – Pain control and watching the patient’s face during dressing changes
37:01 – What the dressing and wound bed should tell you
37:35 – Antibiotics: best antibiotic is good debridement
40:27 – Logistics in UW: travel light, use partner supplies, stay off the radar
42:47 – When is the wound ready for delayed primary closure?
45:45 – What Jason wishes more medics would internalize

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Recorded live at SOMA 26
Pierre Pasquier (France) and his German counterpart deliver a clear-eyed assessment of how European military medical systems are preparing for large-scale combat operations and major engagements, drawing heavily on lessons from Ukraine. They examine the scale of expected casualties, the return of mass-casualty and prolonged-care realities, the threat of multi-drug-resistant organisms, the vulnerability of medical treatment facilities to deliberate attacks, and the urgent need for true multinational interoperability. The discussion covers doctrine updates, shared training, data collaboration, civilian-military integration, and the strategic value of medical readiness as a deterrent.
Sponsored by the Special Operations Medical Association.
Key Takeaways
Ukraine has demonstrated casualty rates of several hundred per day—orders of magnitude higher than Iraq/Afghanistan—requiring European medical systems to plan for mass casualties, prolonged field care at scale, and significant disease/non-battle injury burdens, including older soldiers with chronic conditions.
Multi-drug-resistant bacteria are already arriving in European hospitals via Ukrainian patients; mass-casualty flows will amplify this biosecurity challenge and demand coordinated infection-control strategies.
Systematic attacks on healthcare facilities necessitate a shift to flexible, mobile, low-signature medical treatment facilities that can hide and defend themselves—something current large Role 1–3 structures are not yet optimized for.
Lessons from long-evacuation environments (e.g., Sahel) must now be scaled from a handful of patients to dozens or hundreds simultaneously; prolonged care is no longer an exception but a planning assumption.
True interoperability requires shared language, clear capability definitions across nations, joint data collection and analysis, and training that moves beyond parallel national exercises to actual patient and team cross-flow.
Germany is positioned as a key NATO medical hub for strategic evacuation; France is actively building civilian-military pathways so that civilian systems can absorb returning casualties while military teams remain forward.
Medical superiority and demonstrated preparedness function as a strategic deterrent; “stronger together” through SOMA, CMC, shared science, and multinational training is essential.

Chapters
00:00 – Introduction and European context01:50 – Ukraine as the current laboratory and weekly French/German learning process03:10 – NATO Eastern Front realities and multinational medical challenges05:00 – Casualty rate comparisons: WWII → Ukraine and implications for doctrine07:00 – Disease, non-battle injury, and the multi-drug-resistant bacteria threat09:50 – Attacks on healthcare facilities and the need for mobile, low-signature MTFs12:20 – Lessons from the Sahel: prolonged care scaled for LSCO14:50 – Interoperability experience and the value of shared data and science17:40 – Changing mindsets, nomenclature, and national doctrines (French Sauvetage au Combat update)21:40 – Training together: Vigorous Warrior and the next steps for joint exercises23:10 – Strategic MEDEVAC, Germany as hub, and civilian-military integration25:10 – Take-home messages: new/old challenges, medical superiority as deterrent, stronger together27:20 – Q&A: hospital capacity concerns and integrating U.S. physician assistants

In this episode of the Prolonged Field Care Podcast, Dennis sits down with Mitch (U.S. family practice/ER physician) and Augustine (frontline surgeon with five years of experience) to unpack what it actually takes to build and sustain mobile surgical capability in a high-threat Asian conflict zone.
They share the hard-won realities of operating close enough to hear the fighting—often within a mile—while remaining mobile enough to survive repeated bombings. You’ll hear how a pre-war physician assistant training program created a ready pool of skilled local providers, how an engineering student turned a broken village diesel generator into life-saving power, and how two family tents duct-taped together became an operating theater.
Key topics include life-saving procedures that can actually be done under those constraints (chest tubes, hemorrhage control, laparotomy, emergency C-sections), the critical role of a pre-arranged walking blood bank, the art of improvisation (urine catheter as chest tube), the security reasons civilians and fighters refuse local government hospitals, and why underground facilities are often impossible. Most importantly, they discuss the non-negotiable principles: local invitation and ownership, language and cultural integration, knowing why you are there, and the constant tension between capability and mobility.
This is practical, unfiltered prolonged field care for anyone preparing to operate—or train others to operate—when the next facility is days away and the sky is full of drones.

Key Takeaways
Pre-war training programs (5-year PA model focused on the 80% of common regional problems + trauma) create the only sustainable talent pipeline.
Mobility is survival: plan the next location before you need it; a full move still costs roughly one day to tear down and one day to stand up.
Improvisation is a core clinical skill—urine catheters become chest tubes when the real ones run out.
Walking blood banks beat stored products in this environment if you pre-type the team and cultivate local donors before the first patient arrives.
Community ownership and language fluency are force multipliers and personal survival tools; operating without local invitation is a fast way to get people killed.
Generators, headlights, and ambulance patterns create detectable signatures; concealment and rapid patient throughput matter more than concrete.

Chapters
00:40 – Why Mobile Surgical Teams Are Essential in Modern Conflict
01:55 – Pre-War Training Program & Building a Ready Talent Pool
03:00 – First Lessons from the Golden Week Reality
04:30 – Improvising the Facility: Generators, Tents, and Operating Tables
07:00 – The Mobility Dilemma: What You Carry vs. What You Leave
09:30 – Life-Saving Procedures Actually Performed on the Front Line
13:00 – Critical Thinking & Improvisation in Action (Urine Catheter Chest Tube)
14:20 – Walking Blood Bank Strategy & Community Engagement
17:00 – Language, Trust, and Why Local Integration Keeps You Alive
19:00 – Why Patients Bypass Nearby Hospitals
21:00 – Access, Invitation, and Working Under Local Leadership
23:00 – How Close Is Too Close? Drones, Signatures & Site Selection
26:00 – Triage, Patient Flow & Pre-Arranged Evacuation Pathways
28:00 – Sourcing Supplies Without Becoming a Target
32:00 – Faith, Motivation & Enduring Under Fire
32:40 – Underground Facilities vs. Pure Mobility (Ukraine Comparison)
36:00 – How Long Do You Stay? Reading the Threat & Knowing When to Move
38:00 – Final Reflections: People Over Adrenaline

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Recorded live at SOMA 26
Dr. Emily Johnston (Cascadia Mountain Institute) and SFC Ezequiel Mendoza (Arctic Dustoff, Fairbanks) deliver a hard-hitting, field-validated look at how standard tactical medical gear and medications actually perform—and fail—in true Arctic and extreme cold conditions. Drawing from cold-soak testing, simulated combat exercises, and real operational experience, they break down battery and fluid-warmer failures, rapid freezing of IV tubing and blood sets, medication storage realities, tourniquet performance, and the critical need for early frostbite interventions like ibuprofen and iloprost far forward. Practical fieldcraft solutions, insulation strategies, and clear calls for better-designed cold-weather medical systems are front and center.
Key Takeaways
No electronic or mechanical medical device (IV pumps, Buddy Lite warmers, etc.) can be trusted to operate unprotected in Arctic conditions—insulate everything, including fluids and tubing.
Fluids and tubing freeze extremely quickly and become brittle; passive warming solutions using insulated containers + chemical heat packs can keep fluids viable for many hours even at –20°F to –30°F.
Body heat (base-layer transport systems worn against the skin) is the only reliably consistent way to prevent medication freezing during multi-day cold operations; outer pockets, med boxes, and sling packs routinely fail.
Current blood administration sets create major clotting and failure points in the cold; shorter, fully insulated, or redesigned kits are needed.
Most common tourniquets performed adequately after freeze-thaw cycles; metal windlasses held up better than plastic ones under extreme cold.
Reperfusion injury is the dominant mechanism of tissue loss in frostbite. Early NSAID (ibuprofen) loading and rapid iloprost administration dramatically improve outcomes, yet cold-chain and far-forward delivery of iloprost remain unsolved problems.
Manufacturer claims about extreme-cold performance often do not match real-world Arctic testing. Independent field validation is essential before relying on any device or medication in these environments.
Chapters00:00 – Introduction & Arctic strategic context
04:45 – Operational realities: long evacuation times and limited cold-weather experience
06:00 – Battery and device cold-soak testing (IV pump & Buddy Lite)
09:20 – Functional testing: frozen pumps, ruptured warmer cartridges, and fluid output
11:40 – Practical insulation and pre-warming techniques for fluids
13:40 – Medication transport failures vs. base-layer body-heat solutions
18:50 – Blood product challenges and call for redesigned cold-weather kits
20:20 – Tourniquet performance after freeze-thaw cycles
21:15 – Frostbite pathophysiology and the critical role of early ibuprofen + iloprost
27:20 – Path forward: needed research, device redesign, and medication stability after freezing
29:40 – Closing remarks and Q&A discussion
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In this essential episode of the Prolonged Field Care Podcast, Dennis sits down with pediatric intensivist Dr. Sara Bibbens to tackle one of the most challenging and anxiety-inducing scenarios in austere medicine: pediatric burns. From initial trauma assessment using MARCH/ABCDE to nuanced airway decisions in small children, burn resuscitation formulas, fluid management pitfalls, hypothermia prevention, wound care, and safe pain/sedation strategies, this conversation delivers practical, downrange-applicable guidance every combat medic, flight medic, and austere provider needs.
Key Takeaways:
Stick to MARCH/ABCDE — don’t get distracted by dramatic burns; treat life threats first.
Pediatric airways swell faster — early intubation considerations (GCS <8, large TBSA, stridor, facial burns, soot).
Initial fluid resuscitation rates by age + precise TBSA calculation using the Consensus Formula (3 mL × kg × %TBSA).
Add maintenance D5 fluids in kids <30 kg and titrate everything to urine output goals (1 mL/kg/hr under 30 kg; 0.5 mL/kg/hr over 30 kg).
Plasma-based resuscitation is preferred when available.
Hypothermia prevention is more critical in children due to higher BSA-to-mass ratio.
Pain management: Start low with opioids (morphine preferred), ketamine for dissociation/procedural sedation; watch for respiratory depression when combining meds.
Avoid routine prophylactic antibiotics; focus on source control and dry dressings.
Whether you’re operating in contested environments, remote settings, or supporting pediatric casualties, this episode arms you with the knowledge to avoid common pitfalls like fluid creep and over-resuscitation while delivering life-saving care.
Website: ⁠www.prolongedfieldcare.org⁠
Follow @prolonged_field_care on Instagram for carousels, reels, and more austere medicine content.
Subscribe and stay on the bleeding edge of combat casualty care.
Episode Chapters00:00 - Introduction & Welcome
00:46 - Guest Introduction: Dr. Sara Bibbens, Pediatric Intensivist
01:04 - Initial Assessment: MARCH/ABCDE in Burned Pediatric Patients
02:43 - Prioritizing Life Threats Over Dramatic Burns
03:37 - Airway Management in Children: When to Intubate?
06:11 - Surgical Airway Limitations & Head Positioning in Pediatrics
07:42 - Burn Resuscitation: Initial Fluids & Rule of Tens Limitations
08:04 - Pediatric Lund-Browder Chart, TBSA Estimation & Consensus Formula
11:46 - Maintenance Fluids (D5) + 4-2-1 Rule in Kids <30 kg
13:26 - Glucose Goals & Dextrose Fluid Mixing in Austere Settings
14:14 - Urine Output Goals & Endpoints for Resuscitation
16:15 - Avoiding Fluid Overload & Fluid Creep in Pediatrics
19:00 - Plasma Resuscitation (Vanderbilt Protocol) in Burns
20:25 - Titration Strategy: Urine Output Over Fixed Formulas
21:52 - Creative Urine Output Measurement (Diaper Weights)
22:59 - Hypothermia Prevention in Children (Large Head, High BSA:Mass)
24:26 - Wound Care & Why to Avoid Prophylactic Antibiotics
25:37 - Pain & Sedation Management: Opioids, Ketamine Dosing & Monitoring
28:46 - Common Pitfalls: Fluid Over-Resuscitation
29:48 - Managing Fluid Overload & Closing Thoughts